Lead Specialist - Claims (Fraud, Waste & Abuse)

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About the Role

Assess outpatient and inpatient hospitalization claims from Group policyholders as per stipulated benchmarks and requirements.

• Perform end‑to‑end FWA investigations in accordance with established investigation frameworks, governance standards and confidentiality requirements

• Identify, analyze and assess suspicious or potentially fraudulent claims by reviewing claims documentation and interpreting transactional, behavioral and historical claims data

• Apply risk‑based investigation techniques to prioritize cases, balancing investigation depth, timeliness and potential financial or reputational impact

• Conduct claimant, provider or third‑party interviews where required, ensuring adherence to investigation protocols, professionalism and non‑tipping‑off principles

• Verify claim documentation and supporting records, identifying indicators of forged, altered or inconsistent information using structured review methods and available digital validation tools

• Prepare clear, accurate and well‑documented investigation findings, case notes and reports for review, escalation or submission to the SG Fraud team

• Utilize claims analytics, rule‑based detection outputs and AI‑enabled insights (where available) to support case assessment, pattern identification and investigation decision‑making

• Contribute to fraud trend monitoring by highlighting emerging fraud typologies, abnormal behaviors or systemic vulnerabilities observed during investigations

• Support claims processing activities during peak periods, surge volumes or contingency situations, while maintaining vigilance on fraud risks and adhering to quality and control standards

Requirements

• Minimum 6 years of experience assessing inpatient and outpatient medical reimbursement claims, with a solid understanding of billing practices.

• Minimum 3 years of experience medical claims investigation. Experience on Fraud, Waste and Abuse (FWA) will be an added advantage.

• Bachelor's degree in Biomedical Science, Biotechnology, Biology, Health Science or related fields.

• Demonstrated ability to analyze claims data and detect abnormal billing patterns.

• Strong analytical and problem‑solving skills, with high attention to detail and accuracy when reviewing claims and supporting documentation.

• Office Location: We will be moving to IOI Tower, Putrajaya in Quarter 3 of 2026.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

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